Choriocarcinoma Component Research Articles

Adénocarcinome gastro-intestinal à composante choriocarcinomateuse : à propos de 2 cas et revue des 120 cas de la littérature

Gastrointestinal adenocarcinoma with a choriocarcinomatous component (GACC) is an extremely rare and highly malignant human chorionic gonadotrophin-producing neoplasm. The development of this tumour from dedifferentiation or trans-differentiation of adenocarcinomatous cells is the most likely mechanism. 102 of the 120 cases reviewed in the literature presented enough clinicopathological information to be analysed. This tumour can be purely choriocarcinomatous or associated with an adenocarcinoma as in half of the observations. It is usually found in the stomach although it may be found throughout the digestive tract. The diagnosis of GACC should only be retained after having clearly eliminated a metastasis from a choriocarcinoma in particular in the gonads. The prognosis is very poor in particular in the gastric forms of this disease, with death observed within 12 months following diagnosis in 2/3 of the patients. There is no treatment consensus, and it is decided on a case-by-case basis.

Topoisomerase II Alpha Expression in Testicular Germ Cell Tumors

Inhibitors of topoisomerase II alpha (TopoIIalpha), an enzyme with a crucial role in DNA maintenance, are included in the chemotherapy protocols for testicular germ cell tumors (GCTs). Despite the success of current chemotherapy regimens, a significant number of patients experience relapse. We analyzed TopoIIalpha expression in primary and metastatic testicular GCTs because this enzyme is a target for some antineoplastic agents. Primary GCT specimens from 109 patients, including 57 seminomas and 52 mixed GCTs (41 embryonal carcinomas, 23 yolk sac tumors, 19 seminomas, 8 choriocarcinomas, 17 teratomas with immature elements, and 16 teratomas with mature elements), were obtained from our archives. The metastatic lesions from 11 of the patients with mixed GCTs included seven teratomas with mature components, five embryonal carcinomas, one yolk sac tumor, one choriocarcinoma, and one teratoma with immature components. Representative sections were subjected to immunohistochemistry with monoclonal antibody against TopoIIalpha, and the nuclear staining findings were evaluated. Most embryonal carcinoma (100%), yolk sac tumor (95%), seminoma (88%), and choriocarcinoma (62%) components of the GCTs were TopoIIalpha immunoreactive. None of the teratoma specimens with mature elements expressed TopoIIalpha. The results of our study have shown that TopoIIalpha is expressed in most seminomas, embryonal carcinomas, yolk sac tumors, and choriocarcinomas, suggesting a possible mechanism of sensitivity of these components to TopoIIalpha inhibitors. Teratomas with mature and immature elements expressed low levels of TopoIIalpha, which might contribute to their chemoresistance. These findings imply that the variable chemoresponsiveness of testicular GCTs could have an underlying molecular basis.

Outcome of patients with stage II and III nonseminomatous germ cell tumors: Results of a single center

The prognostic factors in nonseminomatous germ cell tumors have been mainly derived from the analysis of stage I tumors. The aim of this study was to evaluate some prognostic factors and the outcome of patients with stage II and III nonseminomatous germ cell tumors according to risk groups treated between 1993 and 2002. Patients were retrospectively classified as good, intermediate and poor risk groups according to International Germ Cell Cancer Consensus Group. Biopsy specimens of 58 patients with stage II and III nonseminomatous germ cell tumors were analyzed by means of tumor histopathology, primary localization site of the tumor, relapse sites, initial serum tumor marker levels, the presence of persistent serum tumor marker elevation and the patients' outcome. Kruskall Wallis test and Mann-Whitney U test were used to determine the differences between the groups. Kaplan-Meier method was used for survival analysis and log rank test was used to compare the survival probabilities of groups. Cox proportional hazard analysis was used to determine the prognostic factors in univariate and multivariate analysis. Five-year overall and disease-free survival rates were calculated as 85% and 75% in stage II; 44% and 29% in stage III cases, respectively. Fifty-seven percent of patients were classified in good risk, 9% in intermediate risk and 27% in poor risk groups. Five-year overall survival rates were 97%, 75% and 7% (P<0.001) and disease-free survival rates were 83%, 34% and 7% (P<0.001) in good, intermediate and poor risk groups, respectively. Analysis of the prognostic factors revealed that the localization site of the primary tumor (P<0.001), the initial beta-HCG level (p:0.0048), the presence of yolk sac and choriocarcinoma components in tumor (p:0.003 and p:0.004), relapse sites of tumor (lung versus other than lung) (p:0.003), persistent elevation of serum tumor markers (P<0.001) were significant prognostic factors in univariate analysis. However, in multivariate analysis, only the localization site of tumor (p:0.049) and the relapse site (p:0.003) were found statistically significant. This retrospective study revealed that in advanced stage of nonseminomatous germ cell tumors, the outcome is essentially related with the localization site of the tumor and the relapse site.

Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation - A case report -

A choriocarcinoma of the rectum is extremely rare and has a very poor prognosis. Its rarity and the obscurity of its histogenesis make the entity of disease hard to define. We report a case of a choriocarcinoma of the rectum which showed synchronous liver and lung metastasis. A 52-year- old male patient presented with tenesmus, hematochezia and pain on defecation for 4 months. The preoperative colonoscopy revealed a mass at the rectum, 3 cm proximal to the anal verge. The biopsy revealed a poorly differentiated adenocarcinoma. An abdominoperineal resection was performed, and the pathologic examination confirmed a choriocarcinoma arising from an adenocarcinoma. Immunostain for β-human chorionic gonadotropin (hCG) was strongly positive for the choriocarcinoma component. Serum hCG checked postoperatively was as high as 4,222 IU/L, but the serum carcinoembryonic antigen (CEA) was normal. Although chemotherapy was begun at the 5th week after the operation, the patient died on the 47th day after the operation. A choriocarcinoma of the colon or the rectum is very rare and is aggressive. Although radical resection and chemotherapy are performed, the clinical outcome is very disappointing. Even though a choriocarcinoma of the colon or the rectum is very rare, it should be included on the list for differential diagnosis of a colorectal carcinoma.

Glypican 3: A Novel Marker in Testicular Germ Cell Tumors

Glypican 3 (GPC3), a membrane-bound heparin sulfate proteoglycan, may play a role in promoting embryonic cell growth and differentiation. GPC3 is mutated in Simpson-Golabi-Behmel syndrome, characterized by tissue overgrowth and an increased risk of embryonal malignancies. Recently, GPC3 was reported to be one of the over-expressed genes in testicular yolk sac tumors by gene expression microarray analysis. However, the presence of the GPC3 protein in germ cell tumors has never been investigated. The purpose of the study was to investigate the GPC3 expression in various histologic components of testicular germ cell tumors using immunohistochemistry and to assess its possible utility as a diagnostic marker. Tumors from 71 patients were examined, including components of 42 seminomas, 37 embryonal carcinomas, 24 yolk sac tumors, 20 teratomas with mature elements, 16 teratomas with immature elements, and 7 choriocarcinomas. Cytoplasmic and membranous immunoreactivity was semiquantitatively evaluated. All yolk sac tumor (24/24) and choriocarcinoma (7/7) components were immunoreactive for GPC3, whereas only 38% of teratomas with immature elements and 8% of embryonal carcinomas expressed GPC3. There was no immunoreactivity in benign testicular tissue, intratubular germ cell neoplasia, seminomas (0/42), or teratomas with mature elements (0/20). We conclude that the oncofetal protein GPC3 is a novel immunohistochemical marker in testicular germ cell tumors with differential expression in defined histologic subtypes. Our findings suggest a possible role of GPC3 in tumor cell differentiation. Furthermore, GPC immunostaining may be useful in the pathologic diagnosis of nonseminomatous germ cell tumors, particularly yolk sac tumor, and choriocarcinoma.

Seröses Endometriumkarzinom mit choriokarzinomatöser Komponente

Non-gestational extragonadal choriocarcinomas are extremely rare. A 61-year-old G3 and P3 underwent hysterectomy and bilateral salpingo-oophorectomy and pelvic lymph node sampling for endometrial carcinoma. Histologic examination revealed a serous carcinoma with a choriocarcinomatous component. Postoperatively serum HCG was 225000IU/l. Because of diffuse pulmonary metastatic disease with respiratory problems the patient was initially treated with methotrexate and folinic acid rescue. After three cycles chemotherapy was switched to the EMA-Co scheme because of rising HCG levels. After five cycles of EMA-Co HCG values declined and partial resolution of pulmonary metastatic disease was seen. Because of the metastatic disease and most likely due to the chemotherapeutically induced immunodeficiency, the patient died from pneumonia two months after the initial diagnosis. Endometrial adenocarcinoma with a choriocarcinomatous component is an aggressive neoplasm and should be treated as gestational choriocarcinoma.

Serous Carcinoma of the Endometrium with Choriocarcinomatous Differentiation

Nongestational choriocarcinomas rarely occur outside the gonads or teratomas. We report a serous carcinoma of the endometrium with a choriocarcinomatous component and review of the literature. A 61-year-old woman underwent hysterectomy and bilateral salpingo-oophorectomy for a serous carcinoma with choriocarcinomatous component. Immunohistochemistry showed a strong p53 staining of the serous component and the cytotrophoblastic cells of the choriocarcinomatous component; the syncytiotrophoblast was negative. The initial serum human chorionic gonadotropin (hCG) was 225,000 IU/L. Postoperatively, the patient developed diffuse pulmonary metastatic disease. Despite chemotherapy, the patient died 2 months after initial diagnosis. Abstracting the data from the reported cases and from the literature, it can be assumed that 2 different tumor types exist. The first one is morphologically and clinically more related to the gestational choriocarcinoma with strongly elevated serum hCG levels, early onset of (distant) metastatic disease, and consecutively rapid and often fatal clinical course. The second type presents as an endometrial carcinoma with single syncytiotrophoblast-like cells, associated with low serum hCG, no distant metastatic disease, and, consequently, a better prognosis. The prognostically relevant component for long-time survival in the latter variant is the nontrophoblastic component.

Primary pulmonary choriocarcinoma combined with adenocarcinoma

An extremely rare autopsy case of primary pulmonary choriocarcinoma combined with adenocarcinomatous components in a 77-year-old Japanese man is described. The patient died of rapidly progressive respiratory dysfunction without ante-mortem diagnosis. Autopsy revealed necro-hemorrhagic areas of the primary lung tumor with a typical biphasic pattern of choriocarcinoma. Topographical analysis suggested that moderately to poorly differentiated adenocarcinoma components partially surrounded the choriocarcinomatous components. Moreover, dedifferentiated carcinomatous components were scattered next to both adenocarcinomatous and choriocarcinomatous areas, and a few cells of the dedifferentiated carcinomatous components had a similar immunoreaction to conventional adenocarcinomatous or choriocarcinomatous components, such as surfactant apoprotein A, placental alkaline phosphatase or beta-human chorionic gonadotropin. Additionally, epithelial membrane antigen-positive cytotrophoblastic cells were rarely found in choriocarcinomatous areas. The present case suggests that primary lung choriocarcinoma can occur closely related to conventional pulmonary adenocarcinoma, although collision tumor was not completely ruled out.

Choriocarcinoma involving the pancreas as first manifestation of a metastatic regressing mixed testicular germ cell tumor

We describe an unusual case of metastatic choriocarcinoma of the pancreas arising from a regressing testicular mixed germ cell tumor that clinically mimicked a primary pancreatic tumor. A 54-year-old male presented with a 2-month history of progressive upper abdominal pain, weight loss, and jaundice. He also had a history of recurrent epididymitis associated with the presence of a right testicular mass shown to be cystic by ultrasound and stable for at least 10 years. A computed tomography scan showed an isolated 6 cm mass in the head of the pancreas. A pancreaticoduodenectomy was performed. Upon histological examination, the pancreatic tumor showed extensive hemorrhage and necrosis. In the viable area, the tumor was composed of an intimate mixture of mononuclear cytotrophoblast cells and multinucleated syncytiotrophoblasts with vascular invasion. These characteristic features led to the correct diagnosis on frozen section. The cytology of the tumor was nonspecific and suggested undifferentiated carcinoma of the pancreas. The trophoblastic origin of the tumor cells was confirmed by immunohistochemistry staining. The testicular mass showed a regressed mixed germ cell tumor of predominantly seminoma with focal teratoma but without a choriocarcinoma component. In conclusion, we present a rare and unusual case of a regressing testicular mixed germ cell tumor that presented as a primary pancreatic tumor. Cytological features of the pancreatic mass were not specific and raised the possibility of a primary undifferentiated carcinoma of the pancreas. Characteristic histological features of choriocarcinoma led to the correct diagnosis on frozen section. Subsequent resection of the testicular mass confirmed the presence of a cystic and scarring (regressing) mixed germ cell tumor but without evidence of choriocarcinoma.

Factors affecting prognosis in stage II and III testicular non-seminomatous germ cell tumors

9701 Background: Some patients in advanced stage of testicular germ cell cancers die due to unresponsiveness to treatment or disease progression. Many prognostic factors have been investigated up to date. Results apropos MIB-1 and HER-2/neu are still conflicting. Methods: 58 cases were enrolled in the study. Initial serum AFP and βHCG, histopathology, relapse sites, persistent tumor marker elevation and tumor sites were noted. Cases were classified according to International germ cell consensus as good, intermediate and poor prognosis. Cross sections were obtained retrospectively from tissue blocks and MIB-1, HER-2/neu, vascular density were evaluated by immunohistochemical method. Vascular invasion was identified for all specimen. Results were analysed with uni and multivariate analysis. Results: 22% were primary refractory (100% died) and 20% were later-relapsed cases (33% died). 57%, 9% and 27% of the cases were classified as good, intermediate and poor risk groups, respectively. 31% in good, 11% in intermediate and 0% in poor risk groups could achieve remission after relapse. Most important prognostic factors were found tumor site, vascular density, initial serum tumor marker level, existance of yolk sac and choriocarcinoma components, relapse sites (lung vs other than lung), persistent tumor marker elevation in univariate analysis (p: 0.0001, p: 0.0005, p: 0.008, p: 0.0007, p: 0.0034, p: 0.0039, p: 0.0032, and p < 0.001). Tumor site, choriocarcinoma component and initial serum AFP level were most expressive prognostic factors in multivariate analysis (p: 0.0017, p: 0.049 and p: 0.0009). MIB-1 and HER-2/neu were not found prognosticator for survival neither for relapse. Survival was affected mainly by prognosis level (p<0.001). Vascular density and MIB-1 were different between never-relapsed, later-relapsed and primary refractory cases. Vascular invasion nor her-2/neu were different between the three groups. Conclusions: Although MIB-1 level was different in all prognostic groups, it was not significant as prognostic factor as her-2/neu in this study. Vascular density may be a good prognosticator as well as other known predictors. No significant financial relationships to disclose.

Factors affecting prognosis in stage II and III testicular non-seminomatous germ cell tumors

9701 Background: Some patients in advanced stage of testicular germ cell cancers die due to unresponsiveness to treatment or disease progression. Many prognostic factors have been investigated up to date. Results apropos MIB-1 and HER-2/neu are still conflicting. Methods: 58 cases were enrolled in the study. Initial serum AFP and βHCG, histopathology, relapse sites, persistent tumor marker elevation and tumor sites were noted. Cases were classified according to International germ cell consensus as good, intermediate and poor prognosis. Cross sections were obtained retrospectively from tissue blocks and MIB-1, HER-2/neu, vascular density were evaluated by immunohistochemical method. Vascular invasion was identified for all specimen. Results were analysed with uni and multivariate analysis. Results: 22% were primary refractory (100% died) and 20% were later-relapsed cases (33% died). 57%, 9% and 27% of the cases were classified as good, intermediate and poor risk groups, respectively. 31% in good, 11% in intermediate and 0% in poor risk groups could achieve remission after relapse. Most important prognostic factors were found tumor site, vascular density, initial serum tumor marker level, existance of yolk sac and choriocarcinoma components, relapse sites (lung vs other than lung), persistent tumor marker elevation in univariate analysis (p: 0.0001, p: 0.0005, p: 0.008, p: 0.0007, p: 0.0034, p: 0.0039, p: 0.0032, and p < 0.001). Tumor site, choriocarcinoma component and initial serum AFP level were most expressive prognostic factors in multivariate analysis (p: 0.0017, p: 0.049 and p: 0.0009). MIB-1 and HER-2/neu were not found prognosticator for survival neither for relapse. Survival was affected mainly by prognosis level (p<0.001). Vascular density and MIB-1 were different between never-relapsed, later-relapsed and primary refractory cases. Vascular invasion nor her-2/neu were different between the three groups. Conclusions: Although MIB-1 level was different in all prognostic groups, it was not significant as prognostic factor as her-2/neu in this study. Vascular density may be a good prognosticator as well as other known predictors. No significant financial relationships to disclose.

Concurrent ovarian-type primary peritoneal adenocarcinoma and peritoneal choriocarcinoma. A case report and review of the literature

Background. Nongestational choriocarcinomas are aggressive tumours occurring either as a global event or as a focal change in solid tumours. The latter is responsible for coexistence of trophoblastic histology with other malignancies. Case. A 65-year old female with stage IV primary peritoneal carcinoma, ovarian type, underwent surgical cytoreduction followed by two courses of paclitaxel/carboplatin chemotherapy. A choriocarcinomatous component was later identified in the resection specimens, as chemotherapy resulted in a differential response of the two malignant variants. Commencement of EMA/CO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) resulted in symptom palliation and tumour regression, further consolidated with platinum-based EP/EMA (etoposide, cisplatin, methotrexate, actinomycin D). Two months later, relentless choriocarcinomatous disease progression followed, leading to the patient's death while the peritoneal adenocarcinomatous variant remained biochemically quiescent. Conclusion. Choriocarcinomas may coexist with typical ovarian-type peritoneal cancer, creating diagnostic and therapeutic dilemmas. Aggressive weekly chorio-type chemotherapy appears to be warranted despite the low likelihood of cure, as it provides significant symptom palliation.

Epidermal growth factor receptor is a marker for syncytiotrophoblastic cells in testicular germ cell tumors.

The epidermal growth factor receptor (EGFR) has been implicated in the pathogenesis, therapy and prognosis of various tumor types. The aim of this study was to investigate EGFR expression in a large series of testicular germ cell tumors (TGCTs). A total of 88 TGCTs (37 of pure type and 51 of mixed type) comprising a total of 44 seminoma, 49 embryonal carcinoma, 32 yolk sac tumor, 28 teratoma and 7 choriocarcinoma components were immunostained for EGFR. EGFR reactivity was observed in the stromal cells of embryonal carcinoma (29%) and in epithelial compartments of teratoma (71%). In addition, EGFR staining was consistently detected in syncytiotrophoblastic cells of choriocarcinoma, seminoma, embryonal carcinoma and yolk sac tumor components. EGFR staining, similar to beta-human chorionic gonadotropin (HCG) immunohistochemistry, was efficiently able to identify syncytiotrophoblastic cells in TGCTs. This study shows that EGFR is expressed in a subset of testicular germ cell tumors and suggests that EGFR may be a useful marker for syncytiotrophoblastic cells.

Inhibin-α, CD99, HEA125, PLAP, and chromogranin immunoreactivity in testicular neoplasms and the androgen insensitivity syndrome

We investigated 115 testicular and 3 epididymal tumors and 6 cases of the complete androgen insensitivity syndrome (AIS) for the expression of inhibin-α, CD99, HEA125, PLAP, and chromogranin, using monoclonal antibodies and standard immunhistochemical techniques. Inhibin-α was detected in the neoplastic cells in 27 of 27 primary Leydig cell tumors (LCTs), 1 of 1 metastatic LCT, 6 of 20 Sertoli cell tumors (SCTs), 4 of 5 juvenile granulosa cell tumors (JGCTs), and 2 of 5 unclassified sex cord–stromal tumors (USCSTs). Except for 2 choriocarcinomas, the choriocarcinomatous component of 1 mixed germ cell tumor, and a small focus of inhibin-positive syncytiotrophoblast in 1 embryonal carcinoma, inhibin-α immunoreactivity was not present in the neoplastic cells of the 38 remaining testicular germ cell tumors; 11 B-cell and 1 T-cell lymphomas; 1 granulocytic sarcoma; and 1 rhabdomyosarcoma of the testis; 1 adenoma of the rete testis, and 3 adenomatoid tumors of the epididymis. Inhibin-α immunoreactivity was present in the Sertoli cells and Leydig cells in 5 testicular hamartomas and in 1 Sertoli cell adenoma in 6 cases of AIS; both Sertoli and Leydig cells were also positive in the extranodular testicular parenchyma present in 2 of these cases. CD99 was detected in 10 of 15 primary LCTs, 1 of 7 SCTs, 3 of 5 JGCTs, and in 1 of 5 USCSTs but was not found in any tumor outside the sex cord–stromal category. HEA125 immunostaining was not detected in sex cord–stromal tumors; however, 3 of 12 seminomas, 3 of 12 embryonal carcinomas, 6 of 8 yolk sac tumors, and 1 of 2 teratomas were HEA125 positive. PLAP was not detected in sex cord–stromal tumors except for 4 of 15 primary LCTs but was present in most germ cell tumors. Chromogranin immunostaining was present in the sex cord–like element in 1 of 5 USCSTs, 1 of 8 YSTs, 1 of 2 teratomas, and in 1 of 1 rete adenoma, and in normal adjacent rete testis. In conclusion, although inhibin-α and PLAP, and, to a somewhat lesser extent, CD99 and HEA125 immunostaining are helpful in the differential diagnosis of certain testicular neoplasms that are difficult to distinguish on morphologic grounds, chromogranin is far less helpful in this context. H UM P ATHOL 31:1055-1061.

Carcinosarcoma of the Uterus Associated With a Nongestational Choriocarcinoma

Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant müllerian mixed tumor) in a 71-year-old woman whose hysterectomy specimen revealed two polypoid lesions of the endometrium, one arising from the anterior endometrium and one arising from the posterior endometrium. Histologic examination revealed three histologic patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid endometrial adenocarcinoma. The posterior endometrial lesion showed a carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous stromal sarcoma. In addition, a choriocarcinoma was identified intermixed with the adenocarcinoma. The syncytiocytotrophoblasts and cytotrophoblasts stained strongly with 0 human chorionic gonadotropin (beta-hCG) and human placental lactogen (hPL). The patient's beta-hCG levels on postoperative days 14, 27, and 42 were 283, 32, and 7 mIU/mL, respectively. This unusual case suggests the importance of identifying the choriocarcinomatous component, since the serum beta-hCG can serve as a marker of tumor recurrence postoperatively.

Gastric carcinoma with predominant choriocarcinomatous component

We describe a rare case of gastric carcinoma with choriocarcinomatous differentiation. A 64-year-old Japanese man presented with an abdominal mass and was admitted to our hospital. Barium meal and endoscopic examinations disclosed a Borrmann type 2 tumor on the anterior wall of the gastric body. A subtotal gastrectomy was performed. Histopathological and immunohistochemical examinations demonstrated mostly choriocarcinomatous differentiation of the tumor, in addition to tubular adenocarcinoma. The serum human chorionic gonadotropin (hCG) level, measured after a histopathological diagnosis was made postoperatively, was 1200IU/ml (normal range, <1.0IU/ml). Despite resection of the tumor and chemotherapy with a curative intent, the patient died of liver metastasis 6 months after surgery.

Uterine Carcinoma With Serous and Choriocarcinomatous Differentiation

Nongestational, nongonadal, and nonteratoma-related choriocarcinoma is an extremely rare entity. The tumor may be pure or associated with carcinoma. Six cases of primary endometrial carcinomas with the presence of syncytiotrophoblastlike beta-human chorionic gonadotropin (beta-HCG)-positive cells have been reported. We describe a case of endometrial carcinoma in a postmenopausal woman, that was composed almost entirely of syncytiotrophoblastic and cytotrophoblastic elements, except in the areas of lymphatic and myometrial invasion, where the neoplasm expressed a papillary serous carcinoma conformation with numerous psammoma bodies. There was not a clear transition between choriocarcinoma and serous carcinoma components. Immunohistochemically, beta-HCG was strongly positive in trophoblastic cells, whereas papillary areas expressed epithelial membrane antigen. These results suggest a double differentiation from malignant stem cells toward an extraembryonal germinal line and a papillary epithelial line. A poor prognosis is expected for this type of neoplasm with extraembryonic differentiation. In the present case, the histologic subtype of uterine papillary serous carcinoma could be an additional risk factor.

Cytogenetic analysis of the mature teratoma and the choriocarcinoma component of a testicular mixed nonseminomatous germ cell tumor

We karyotyped two histologically distinct components with different metastatic behavior of a testicular nonseminomatous germ cell tumor. The two components showed an almost identical chromosomal pattern. These almost identical karyotypes of the two components with different metastatic potential suggest that the difference in biologic behavior might result from subtle differences (on microscopic or submicroscopic level) in chromosomal pattern or that these differences are predominantly epigenetically determined and depend primarily on the lineage of differentiation of the tumor component. Trophoblastic differentiation results in an aggressive, angioinvasive tumor but in development of teratoma in a tumor with low malignant potential.

じゅう毛癌の成分を伴う肺へん平上皮癌の１例

症例は59才の男性. 胸部異常陰影を主訴として入院し, 扁平上皮癌と診断して手術を行ったが, 胸膜播種のために試験開胸に終わった.化学療法も効果なく死亡したが, 死亡前の. 血清中β-hCG値が90.4ng/mlと高値を示した.剖検で肺に絨毛癌の成分を伴う扁平上皮癌を認め, 肝, 膵, 腎に絨毛癌の転移を認めた.他に原発と思われる病巣がないため肺原発と診断した. 肺原発の絨毛癌は稀で, 若干の文献的考察を加えて報告した.

Clinical study of testicular tumor: tumor tissue content of hCG in seminoma

Positive cases of serum human chorionic gonadotropin (hCG) have been increased in patients with pure seminoma due to the progress of methods of measuring serum hCG. But the positive ratio and the value of serum hCG in pure seminoma cases are lower than those of non-seminoma cases. The relationship between the pathological type of testicular tumor and the hCG levels in both serum and tumor tissue was investigated, and clinical usefulness of the serum hCG levels as a tumor marker of pure seminoma was discussed. The materials were 19 pure seminomas, 14 non-seminomas and 11 normal testes as controls. HCG and hCG-beta in tumor tissue extracts and in the serum of blood from the spermatic and peripheral veins were measured by radioimmunoassay (RIA). The tissue content of hCG and hCG-beta were 276.7 +/- 136.1 mIU/g.tissue and 16.5 +/- 3.20 ng/g.tissue, respectively, in pure seminoma; 224,376 +/- 91,619 mIU/g.tissue and 4,608 +/- 1,817 ng/g.tissue, respectively, in non-seminoma including choriocarcinoma component; 1,807 +/- 1,428 mIU/g.tissue, and 37.0 +/- 11.2 ng/g.tissue, respectively, in non-seminoma including seminoma component but not including choriocarcinoma component; 20.4 +/- 3.1 mIU/g.tissue and 1.27 +/- 0.38 ng/g.tissue, respectively, in normal testes, (each M +/- SE). The tissue content of hCG-beta in pure seminoma is significantly higher than that in normal testis (p less than 0.01) and significantly lower than that in non-seminoma including choriocarcinoma component.(ABSTRACT TRUNCATED AT 250 WORDS)